NPIMap

Organization Active NPI

Choptank Community Health System, Inc.

Doing business as Federalsburg Medical Center

  • Federally Qualified Health Center (FQHC)
  • Federalsburg, MD
National Provider Identifier
1184840183
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
Doing business as
Federalsburg Medical Center
Practice address
215 Bloomingdale Ave
Federalsburg, MD 21632-1012
Phone
(410) 754-9021
Fax
(833) 908-2285
NPI assigned
Apr 18, 2007
Last updated
Oct 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sara Rich
Title
Ceo
Phone
(410) 479-4306

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

215 Bloomingdale Ave
Federalsburg, MD 21632-1012

Mailing address

215 Bloomingdale Ave
Federalsburg, MD 21632-1012
Phone (410) 754-9021

Other names 1

  • Federalsburg Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071004000540 MD Part A Provider - Federally Qualified Health Center (FQHC) 0648189274 Practice locations: Federalsburg, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184840183. Details of each certification follow.

Federally qualified health center certification: CCN 211803

Legal name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 20, 1978 in MD
Enrollment address
215 Bloomingdale Ave
Federalsburg, MD 21632-1012

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John Masone Individual Corporate DirectorBoard Member Jan 1, 2011
Benjamin Cottle Individual Corporate OfficerCfo Jul 16, 2018
Jennifer W Yost Individual Corporate DirectorBoard Members Feb 1, 2015
Sara K Rich Individual Corporate OfficerCeo Jan 1, 2017
Patrick W Thomas Individual Corporate DirectorBoard Member Jan 1, 2019
Rebecca Loukides Individual Corporate DirectorBoard Member Aug 1, 2016
Crystal L Dadds Individual Corporate DirectorBoard Member Jan 1, 2016
Ivonne Garrido Individual Corporate DirectorBoard Member Jan 1, 2017
Matthew R Peters Individual Corporate DirectorBoard Member Apr 1, 2015
Gary L Long Individual Corporate OfficerChief Operations Officer Mar 6, 2017
Pauline E Pinkett Individual Corporate DirectorBoard Member Apr 1, 2015
Kimberly R Love Individual W-2 Managing EmployeeFinance Director Feb 19, 2002
Sara B Visintainer Individual Corporate DirectorBoard Member Feb 1, 2015

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1184840183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 BLOOMINGDALE AVE",
            "city": "FEDERALSBURG",
            "state": "MD",
            "postal_code": "216321012",
            "telephone_number": "410-754-9021",
            "fax_number": "833-908-2285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 BLOOMINGDALE AVE",
            "city": "FEDERALSBURG",
            "state": "MD",
            "postal_code": "216321012",
            "telephone_number": "410-754-9021",
            "fax_number": "833-908-2285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOPTANK COMMUNITY HEALTH SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-479-4306"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Federalsburg Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Federalsburg Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Federalsburg, MD

Sources for this page

Verify at the official NPI Registry.